a A ‘warm spell’ day is a day when maximum temperature, together with that of at least the 6 consecutive previous days, exceeds the 90th percentile threshold for that time of the year.
b World Population Prospects: The 2015 Revision, UNDESA (2015) c World Urbanization Prospects: The 2014 Revision, UNDESA (2014) d World Development Indicators, World Bank (2015)
e Global Health Expenditure Database, WHO (2014)
f United Nations Development Programme, Human Development Reports (2014) g Global Health Observatory, WHO [2014]
h Levels & Trends in Child Mortality Report 2015, UN Inter-agency Group for Child Mortality Estimation [2015]
CLIMATE AND HEALTH COUNTRY PROFILE – 2015 TUNISIA
DEMOGRAPHIC ESTIMATES
Population (2013)b 11 million
Population growth rate (2013)b 1.1 %
Population living in urban areas (2013)c 66.5 %
Population under five (2013)b 8.6 %
Population aged 65 or over (2013)b 7.4 %
ECONOMIC AND DEVELOPMENT INDICATORS
GDP per capita (current US$, 2013)d 4310 USD
Total expenditure on health as % of GDP (2013)e 7.1 %
Percentage share of income for lowest 20% of population (2010)d 6.8
HDI (2013, +/- 0.01 change from 2005 is indicated with arrow)f 0.721
HEALTH ESTIMATES
Life expectancy at birth (2013)g 76 years
Under-5 mortality per 1000 live births (2013)h 15
OVERVIEW
The Republic of Tunisia is an upper-middle income country in North Africa, bordered by the Mediterranean Sea. In the northern mountainous coastal region, the climate sees mild and rainy winters and dry, hot summers; the south is semi arid desert.
Among Mediterranean countries, Tunisia is one of the most exposed to climate threats [Tunisia INDC, 2015]: facing rising temperatures, reduced rainfall, rising sea levels, and increased frequency of extreme weather events such as floods and droughts.
Climate change in Tunisia may see the resurgence of vector- borne diseases such as malaria, leishmaniasis and dengue fever.
The rise in temperature may exacerbate respiratory diseases, and water-borne diseases may spread due to degradation of the quality of water resources [Tunisia INDC, 2015].
In 2014, Tunisia became the third country in the world to incorporate the need to protect against climate change in its constitution. Tunisia plans to implement adaptation strategies for the health threats of climate change, including capacity building and monitoring of vectors and vector-borne diseases [Tunisia INDC, 2015]. By 2030, Tunisia aims to reduce carbon intensity (GHG emissions against GDP) by 41%, compared to 2010 levels [Tunisia INDC, 2015].
SUMMARY OF KEY FINDINGS
• In Tunisia, under a high emissions scenario, mean annual temperature is projected to rise by about 5.3°C on average from 1990 to 2100. If global emissions decrease rapidly, the temperature rise is limited to about 1.6°C (page 2).
• Under a high emissions scenario, the number of days of warm spella is projected to increase from less than 10 days in 1990
to about 180 days on average in 2100. If global emissions decrease rapidly, the days of warm spell are limited to about 40 on average (page 2).
• In Tunisia, under a high emissions scenario , the risk of vector- borne diseases, such as dengue, could increase towards 2070 (page 3).
• In Tunisia, under a high emissions scenario, and without large investments in adaptation, an annual average of 78,700 people are projected to be affected by flooding due to sea level rise between 2070 and 2100. If global emissions decrease rapidly and there is a major scale up in protection the annual affected population could be limited to about 100 people (page 4).
OPPORTUNITIES FOR ACTION
Tunisia has an approved national health adaptation strategy and has conducted a national assessment of climate change impacts, vulnerability and adaptation for health. Additionally, tunisia is taking action to build institutional and technical capacities to work on climate change and health. Country reported data (see section 6) indicate that there remains opportunities for action in the following areas:
1) Adaptation
• Implement projects on health adaptation to climate change.
• Take action to increase the climate resilience of health infrastructure.
• Estimate costs to implement health resilience to climate change and include these costs in planned allocations.
2) Mitigation
• Conduct a valuation of the health co-benefits of climate change mitigation policies.
COUNTRY-SPECIFIC CLIMATE HAZARD PROJECTIONS
The model projections below present climate hazards under a high emissions scenario, Representative Concentration Pathway 8.5 [RCP8.5] (in orange) and a low emissions scenario, [RCP2.6] (in green).a The text boxes describe the projected changes averaged across about 20 models (thick line). The figures also show each model individually as well as the 90% model range (shaded) as a measure of uncertainty and, where available, the annual and smoothed observed record (in blue).b,c
Due to climate change, many climate hazards and extreme weather events, such as heat waves, heavy rainfall and droughts, could become more frequent and more intense in many parts of the world.
Outlined here are country–specific projections up to the year 2100 for climate hazards under a ‘business as usual’ high emissions scenario compared to projections under a ‘two-degree’ scenario with rapidly decreasing global emissions.
Most hazards caused by climate change will persist for many centuries.
CURRENT AND FUTURE CLIMATE HAZARDS
1 CURRENT AND FUTURE CLIMATE HAZARDS
1
a Model projections are from CMIP5 for RCP8.5 (high emissions) and RCP2.6 (low emissions). Model anomalies are added to the historical mean and smoothed.
b Observed historical record of mean temperature is from CRU-TSv.3.22; observed historical records of extremes are from HadEX2.
c Analysis by the Climatic Research Unit and Tyndall Centre for Climate Change Research, University of East Anglia, 2015.
d A ‘warm spell’ day is a day when maximum temperature, together with that of at least the 6 consecutive previous days, exceeds the 90th percentile threshold for that time of the year.
MEAN ANNUAL TEMPERATURE
DAYS WITH EXTREME RAINFALL (‘FLOOD RISK’)
DAYS OF WARM SPELL (‘HEAT WAVES’)
CONSECUTIVE DRY DAYS (‘DROUGHT’) Under a high emissions scenario, mean annual temperature is
projected to rise by about 5.3°C on average from 1990 to 2100.
If emissions decrease rapidly, the temperature rise is limited to about 1.6°C.
Under a high emissions scenario, the number of days of warm spelld is projected to increase from less than 10 days in 1990 to about 180 days on average in 2100. If emissions decrease rapidly, the days of warm spell are limited to about 40 on average.
Under both high and low emissions scenarios, the number of days with very heavy precipitation (20 mm or more) remains very low, less than 1 day on average. A few models indicate small increases outside the range of historical variability under the high emissions scenario.
Under a high emissions scenario, the longest dry spell is indicated to increase by about 35 days on average, from about 100 days on average in 1990, with continuing large year-to-year variability. If emissions decrease rapidly, the increase is limited to about 6 days on average.
Year
1900 1950 2000 2050 2100 18
20 22 24 26
° C
Year
1900 1950 2000 2050 2100 0
50 100 150 200 250 300
Days
Year
1900 1950 2000 2050 2100 0.0
0.5 1.0 1.5 2.0 2.5 3.0
Days
Year
1900 1950 2000 2050 2100 0
50 100 150 200
Days Year
1900 1950 2000 2050 2100 18
20 22 24 26
° C
Year
1900 1950 2000 2050 2100 0
50 100 150 200 250 300
Days
Year
1900 1950 2000 2050 2100 0.0
0.5 1.0 1.5 2.0 2.5 3.0
Days
Year
1900 1950 2000 2050 2100 0
50 100 150 200
Days
CURRENT AND FUTURE HEALTH RISKS DUE TO CLIMATE CHANGE
2 CURRENT AND FUTURE HEALTH RISKS DUE TO CLIMATE CHANGE
2
Human health is profoundly affected by weather and climate. Climate change threatens to exacerbate today’s health problems – deaths from extreme weather events, cardiovascular and respiratory diseases, infectious diseases and malnutrition – whilst undermining water and food supplies, infrastructure, health systems and social protection systems.
Under a high emissions scenario, and without large investments in adaptation, an annual average of 78,700 people are projected to be affected by flooding due to sea level rise between 2070 and 2100. If global emissions decrease rapidly and there is a major scale up in protection (i.e. continued construction/
raising of dikes) the annual affected population could be limited to about 100 people. Adaptation alone will not offer sufficient protection, as sea level rise is a long-term process, with high emissions scenarios bringing increasing impacts well beyond the end of the century.
Source: Human dynamics of climate change, technical report, Met Office, HM Government, UK, 2014.
The mean relative vectorial capacity for dengue fever
transmission is projected to increase towards 2070 under both a high and low emissions scenario. The increase is greater under a high emissions scenario.
Source: Rocklöv, J., Quam, M. et al., 2015.c
a Atlas of Health and Climate, World Health Organization and World Meteorological Organization, 2012.
b Quantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s. Geneva: World Health Organization, 2014.
c Country-level analysis, completed in 2015, was based on health models outlined in the Quantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s. Geneva: World Health Organization, 2014. The mean of impact estimates for three global climate models are presented. Models assume continued socioeconomic trends (SSP2 or comparable).
ANNUAL EXPOSURE TO FLOODING DUE TO SEA LEVEL RISE, TUNISIA (2070–2100)
INFECTIOUS AND VECTOR-BORNE DISEASES
Mean relative vectorial capacity for dengue fever transmission in Tunisia
Some of the worlds most virulent infections are also highly sensitive to climate: temperature , precipitation and humidity have a strong influence on the life-cycles of the vectors and the infectious agents they carry and influence the transmission of water and food- borne diseases.a
Socioeconomic development and health interventions are driving down burdens of several infectious diseases, and these projections assume that this will continue. However, climate conditions are projected to become significantly more favourable for transmission, slowing progress in reducing burdens, and increasing the populations at risk if control measures are not maintained or strengthened.b
KEY IMPLICATIONS FOR HEALTH
In addition to deaths from drowning, flooding causes extensive indirect health effects, including impacts on food production, water provision, ecosystem disruption, infectious disease outbreak and vector distribution. Longer term effects of flooding may include post-traumatic stress and population displacement.
KEY IMPLICATIONS FOR HEALTH
* Medium ice melting scenario ** Values rounded to nearest ‘00
With Adaptation
Severity of climate change scenario RCP8.5RCP2.6 Without
Adaptation
100
100 12,800
78,700
0.40
0.30
0.20
0.10
0.00
1961–1990 2021–2050
RCP26
Baseline RCP85 RCP26 RCP85
2041–2070
Mean relative vectorial capacity
Climate change is expected to increase mean annual temperature and the intensity and frequency of heat waves resulting in a greater number of people at risk of heat-related medical conditions.
The elderly, children, the chronically ill, the socially isolated and at-risk occupational groups are particularly vulnerable to heat-related conditions.
KEY IMPLICATIONS FOR HEALTH
UNDERNUTRITION
Climate change, through higher temperatures, land and water scarcity, flooding, drought and displacement, negatively impacts agricultural production and causes breakdown in food systems. These disproportionally affect those most vulnerable people at risk to hunger and can lead to food insecurity. Vulnerable groups risk further deterioration into food and nutrition crises if exposed to extreme climate events.b
Without considerable efforts made to improve climate resilience, it has been estimated that the global risk of hunger and malnutrition could increase by up to 20 percent by 2050.b
In Tunisia, the prevalence of stunting in children under age 5 was 10.1% in 2012, the prevalence of underweight children and wasting in children under 5 was 2.3% and 2.8%, respectively, in 2012.c
HEAT-RELATED MORTALITY
a Country-level analysis, completed in 2015, was based on health models outlined in the Quantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s. Geneva: World Health Organization, 2014. The mean of impact estimates for three global climate models are presented. Models assume continued socioeconomic trends (SSP2 or comparable).
b World Food Project 2015 https://www.wfp.org/content/two-minutes-climate-change-and-hunger
c World Health Organization, Global Database on Child Growth and Malnutrition [2015 edition]. Please see source for defintions of child malutrition measures.. Note: these esti- mates are pending re-analysis, see source for further details.
Under a high emissions scenario heat-related deaths in the elderly (65+ years) are projected to increase to about 56 deaths per 100,000 by 2080 compared to the estimated baseline of under 4 deaths per 100,000 annually between 1961 and 1990.
A rapid reduction in global emissions could limit heat-related deaths in the elderly to about 12 deaths per 100,000 in 2080.
Source: Honda et al., 2015.a
Heat-related mortality in population 65 years or over, Tunisia (deaths / 100,000 population 65+ yrs)
RCP2.6 RCP8.5 RCP2.6 RCP8.5 RCP2.6 RCP8.5
2030 2050 2080
1961–1990 Baseline Deaths/100,000 population 65+ years
60 50 40 30 20 10 0
CURRENT EXPOSURES AND HEALTH RISKS DUE TO AIR POLLUTION
3
Many of the drivers of climate change, such as inefficient and polluting forms of energy and transport systems, also contribute to air pollution. Air pollution is now one of the largest global health risks, causing approximately seven million deaths every year. There is an important opportunity to promote policies that both protect the climate at a global level, and also have large and immediate health benefits at a local level.
OUTDOOR AIR POLLUTION EXPOSURE
In Tunisia, most cities for which there was air pollution data available had annual mean PM10 levels that were above the WHO guideline value of 20 μg/m3.
Depending on the results recorded in the annual mean, Sfax city, Ben Arous, Gabes and Manouba control stations
exceeded the permitted levels of Tunisian standards (80 μg/m3), this should be noted and based on digital modeling and to identify the sources of pollution, the majority of PM10 are derived from desert sand.
Outdoor air pollution can have direct and sometimes severe consequences for health.
Fine particles which penetrate deep into the respiratory tract subsequently increase mortality from respiratory infections, lung cancer and cardiovascular disease.
KEY IMPLICATIONS FOR HEALTH
Source: Government of Tunisia.
Outdoor air pollution in cities in Tunisia annual mean PM10 (μg/m3) 2010*
300 250 200 150 100 50 0
Tunis Bizerte
WHO annual mean PM2.5 guideline value (10 μg/m3)
Annual mean PM10, μg/m3
Sfax Ben Arous Sousse Sfax Gabes Mannouba Ariana
Source: Government of Tunisia.
4
a For a complete list of references used in the health co-benefits text please see the Climate and Health Country Profile Reference Document, http://www.who.int/globalchange/en/
Source: Shindell, D., et al, Science, 2012.
CO-BENEFITS TO HEALTH FROM CLIMATE CHANGE MITIGATION: A GLOBAL PERSPECTIVE
Health co-benefits are local, national and international measures with the potential to simultaneously yield large, immediate public health benefits and reduce the upward trajectory of greenhouse gas emissions. Lower carbon strategies can also be cost-effective investments for individuals and societies.
Presented here are examples, from a global perspective, of opportunities for health co-benefits that could be realised by action in important greenhouse gas emitting sectors.a
Transport
Transport injuries lead to 1.2 million deaths every year, and land use and transport planning contribute to the 2–3 million deaths from physical inactivity. The transport sector is also responsible for some 14% (7.0 GtCO2e) of global carbon emissions. The IPCC has noted significant opportunities to reduce energy demand in the sector, potentially resulting in a 15%–40% reduction in CO2 emissions, and bringing substantial opportunities for health: A modal shift towards walking and cycling could see reductions in illnesses related to physical inactivity and reduced outdoor air pollution and noise exposure;
increased use of public transport is likely to result in reduced GHG emissions; compact urban planning fosters walkable residential neighborhoods, improves accessibility to jobs, schools and services and can encourage physical activity and improve health equity by making urban services more accessible to the elderly and poor.
Food and Agriculture
Agricultural emissions account for some 5.0–5.8 GtCO2eq annually, with food and nutrition constituting an im- portant determinant of health. Many high- income countries are feeling the burden of poor diet and obesity-related diseases, with some 1.9 billion adults overweight globally.
A wide range of interventions designed to reduce emissions from agriculture and land-use will also yield positive benefits for public health. For example, policy and behavioural interventions to encourage a reduction in red meat consumption and a shift towards local and seasonal fruit and vegetables, which tend to have lower carbon emissions associated with their production, will improve diets and result in reductions in cardiovascular disease and colorectal cancer.
Healthcare Systems
Health care activities are an important source of greenhouse gas emissions.
In the US and in EU countries, for example, health care activities account for between 3–8% of greenhouse gas (CO2-eq) emissions. Major sources include procurement and inefficient energy consumption. Modern, on-site, low-carbon energy solutions (e.g. solar, wind, or hybrid solutions) and the development of combined heat and power generation capacity in larger facilities offer significant potential to lower the health sector’s carbon footprint, particularly when coupled with building and equipment energy efficiency measures. Where electricity access is limited and heavily reliant upon diesel generators, or in the case of emergencies when local energy grids are damaged or not operational, such solutions can also improve the quality and reliability of energy services. In this way, low carbon energy for health care could not only mitigate climate change, it could enhance access to essential health services and ensure resilience.
Electricity Generation
Current patterns of electricity generation in many parts of the world, particularly the reliance on coal combustion in highly polluting power plants, contribute heavily to poor local air quality, causing cancer, cardiovascular and respiratory disease. Outdoor air pollution is responsible for 3.7 million premature deaths annually. High-income countries still have work to do in transitioning to cleaner and healthier energy sources.
The health benefits of transitioning from fuels such as coal to lower carbon sources, including ultimately to renewable energy, are clear: Reduced rates of cardiovascular and respiratory disease such as stroke, lung cancer, coronary artery disease, and COPD; cost-
savings for health systems; improved economic productivity from a healthier and more
productive workforce.
In Tunisia, by 2030, an estimated 250 annual premature deaths due to outdoor air pollution
may be avoided and near-term climate change mitigated by implementing 14 short lived climate
pollutant reduction measures.
EMISSIONS AND COMMITMENTS
5
A 2ºC upper limit of temperature increase relative to pre-industrial levels has been internationally agreed in order to prevent severe and potentially catastrophic impacts from climate change. Reductions are necessary across countries and sectors. In order to stay below the 2ºC upper limit it is estimated that global annual CO2-energy emissions, currently at 5.2 tons per capita, need to be reduced to 1.6 tons per capita.c
Global carbon emissions increased by 80% from 1970 to 2010, and continue to rise.a,b Collective action is necessary, but the need and opportunity to reduce greenhouse gas emissions varies between countries. Information on the contribution of different sectors, such as energy, manufacturing, transport and agriculture, can help decision-makers to identify the largest opportunities to work across sectors to protect health, and address climate change.
Source: UNFCCC Greenhouse Gas Data Inventory, UNFCCC [2015].
NATIONAL RESPONSEd
TUNISIA ANNUAL GREENHOUSE GAS EMISSIONS (metric tonnes CO2 equivalent)
1992 TUNISIA SIGNS THE UNFCCC
2002 PORTFOLIO OF PROJECTS TO REDUCE GHG EMISSIONS
2003 TUNISIA RATIFIES THE KYOTO PROTOCOL
2007 AIR QUALITY LAW
2008 NATIONAL ENERGY EFFICIENCY PROGRAMME
2009 TUNISIAN SOLAR PLAN (2010-2016)
2010 NATIONALLY APPROPRIATE MITIGATION PLANS
2014 NEW CONSTITUTION STATES CLIMATE MUST BE PROTECTED
a Boden, T.A., G. Marland, and R.J. Andres (2010). Global, Regional, and National Fossil-Fuel CO2 Emissions. Carbon Dioxide Information Analysis Center, Oak Ridge National Laboratory, U.S. Department of Energy, Oak Ridge, Tenn., U.S.A. doi 10.3334/CDIAC/00001_V2010.
b IPCC (2014) Blanco G., R. Gerlagh, S. Suh, J. Barrett, H.C. de Coninck, C.F. Diaz Morejon, R. Mathur, N. Nakicenovic, A. Ofosu Ahenkora, J. Pan, H. Pathak, J. Rice, R. Richels, S.J. Smith, D.I. Stern, F.L. Toth, and P. Zhou, 2014: Drivers, Trends and Mitigation. In: Climate Change 2014: Mitigation of Climate Change. Contribution of Working Group III to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change [Edenhofer, O., R. Pichs-Madruga, Y. Sokona, E. Farahani, S. Kadner, K. Seyboth, A. Adler, I. Baum, S. Brunner, P. Eickemeier, B. Kriemann, J. Savolainen, S. Schlömer, C. von Stechow, T. Zwickel and J.C. Minx (eds.)]. Cambridge University Press, Cambridge, United Kingdom c Pathways to deep decarbonization, Sustainable development Solutions Network, 2014 report.
d Columbia Law School, 'Climate Change Laws Of The World'. N.p., 2015.
The most recent greenhouse gas emissions data for Tunisia is from the year 2000. At that time, carbon emissions were increasing across sectors, with the largest contributions from the agriculture , energy and 'other'* sectors.
Through intersectoral collaboration, the health community can help to identify the best policy options not only to eventually stabilize greenhouse gas emissions, but also to provide the largest direct benefits to health.
* See source for definition of 'other' sector.
1994 2000
40,000,000 35,000,000 30,000,000 25,000,000 20,000,000 15,000,000 10,000,000 5,000,000
Metric tonnes CO equivalent2 0
Energy
Industries Manufac- turing and Construction
Transport Agriculture Waste Other Total excl LULUCF/LUCF
NATIONAL POLICY RESPONSE
6
The following table outlines the status of development or implementation of climate resilient measures, plans or strategies for health adaptation and mitigation of climate change (reported by countries).a
For further information please contact:
World Health Organization 20 Avenue Appia
1211 Geneva 27 Switzerland
Tel.: +41 22 791 3281 | Fax: +41 22 791 4853 http://www.who.int/globalchange/en/
OMMUNICATION – WWW.INISCOMMUNICATION.COM
© World Health Organization 2016
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
The estimates and projections provided in this document have been derived using standard categories and methods to enhance their cross-national comparability. As a result, they should not be regarded as the nationally endorsed statistics of Member States which may have been derived using alternative methodologies.
GOVERNANCE AND POLICY
Country has identified a national focal point for climate change in the Ministry of Health
Country has a national health adaptation strategy approved by relevant government body
The National Communication submitted to UNFCCC includes health implications of climate change mitigation policies HEALTH ADAPTATION IMPLEMENTATION
Country is currently implementing projects or programmes on health adaptation to climate change
Country has implemented actions to build institutional and technical capacities to work on climate change and health
Country has conducted a national assessment of climate change impacts, vulnerability and adaptation for health Country has climate information included in Integrated Disease Surveillance and Response (IDSR) system, including development of early warning and response systems for climate-sensitive health risks
Country has implemented activities to increase climate resilience of health infrastructure FINANCING AND COSTING MECHANISMS
Estimated costs to implement health resilience to climate change included in planned allocations from domestic funds in the last financial biennium
Estimated costs to implement health resilience to climate change included in planned allocations from international funds in the last financial biennium
HEALTH BENEFITS FROM CLIMATE CHANGE MITIGATION
The national strategy for climate change mitigation includes consideration of the health implications (health risks or co-benefits) of climate change mitigation actions
Country has conducted valuation of co-benefits of health implications of climate mitigation policies
a Supporting monitoring efforts on health adaptation and mitigation of climate change: a systematic approach for tracking progress at the global level. WHO survey, 2015.
C/PHE/EPE/15.46
